This invention will be generally discussed in relation to deployment of a stent graft where it is desirable to catheterize a side branch from a main vessel such as to catheterize an iliac artery from a contralateral iliac artery but it is to be understood that the invention is not so limited and may relate to any body lumen in which such a deployment is required. It may, for instance, be used for catheterization of one of the great vessels of the thoracic arch or the renal arteries.
Throughout this specification the term distal with respect to a portion of the aorta, a deployment device or a stent graft means the end of the aorta, deployment device or stent graft further away in the direction of blood flow away from the heart and the term proximal means the portion of the aorta, deployment device or end of the stent graft nearer to the heart. When applied to other vessels similar terms such as caudal and cranial should be understood.
Stent grafts are used for treatment of vasculature in the human or animal body to bypass a repair or defect in the vasculature. For instance, a stent graft may be used to span an aneurism which has occurred in or associated with the iliac artery. In many cases, however, such a damaged or defective portion of the vasculature may include a branch vessel such as an internal iliac artery. Bypassing such a branch vessel without providing blood flow into it can cause problems and hence it has been proposed to provide a side branch or fenestration on a stent graft which when deployed is positioned over the opening to the side vessel and then another stent graft can be deployed through the side branch or fenestration into the side vessel to provide a blood flow path to the side vessel from the stent graft.
There have been proposals, for instance, to deploy a branched stent graft into the common iliac artery via a femoral artery from a femoral incision using the Seldinger technique. Such a branched stent graft has a side arm which is placed to extend into or at least adjacent the internal iliac artery and then a leg extension can be placed through the side arm into the internal iliac artery, however, the use of such devices is very dependent upon favorable layout of the arteries and the ability to obtain access over the aortic bifurcation and in many cases, access is extremely difficult.
It has been proposed to use an indwelling auxiliary catheter positioned in the introducer. To do this it is necessary to snare a guide wire extended from the indwelling auxiliary catheter into or towards the contralateral iliac artery. Snaring can be a problem because of the nature of the prior art indwelling catheters. Prior art indwelling catheters have been constructed from a plastics material which cannot transfer rotational or longitudinal movement from one end to the other. In such a situation the position of the proximal end of the indwelling auxiliary catheter from which guide wire being snared is extended cannot be rotated or extended to direct the auxiliary guide wire in a selected direction and hence the guide wire can become entangled around the nose cone of the introducer or the guide wire of the introducer. This can be a particular problem in the thoracic arch because the great vessels extend off the thoracic arch at a range of angles and it is difficult to rotate the delivery device accurately so high up in the vasculature from the entry point in the groin (for instance).
This invention proposes an alternative method for enabling access for snaring of an indwelling auxiliary guide wire and a deployment device to enable such a method to be practiced.
It is the object of this invention therefore to provide an improved deployment device or at least to provide a physician with a useful alternative.